Asian Journal of Case Reports in Surgery

Background: Splenic cysts are benign lesions which can be revealed by pain or a palpable mass, or present as complications: cyst rupture, intracystic haemorrhage or cyst infection.

Aim: The study aims to report a rare case of a large splenic epidermoid cyst successfully managed by laparoscopic deroofing combined with omentoplasty, highlighting a safe, organ-preserving surgical approach.

Presentation of Case: A 31-year-old female presented with a two-month history of intermittent dull aching pain in the left upper quadrant. Contrast-enhanced CT revealed a large (12.5 × 7 × 8 cm) septated cystic lesion at the upper pole of the spleen. Hydatid serology was negative. She underwent laparoscopic deroofing with omentoplasty without complications and was discharged on postoperative day five. Histopathology confirmed a splenic epidermoid cyst lined by stratified squamous epithelium.

Discussion: Splenic epidermoid cysts are rare congenital benign lesions with a predilection for young women. Laparoscopic deroofing with omentoplasty is a technically feasible, spleen-preserving strategy associated with low morbidity, rapid recovery, and low recurrence rates.

Conclusion: Laparoscopic deroofing with omentoplasty is a safe, effective, minimally invasive treatment for large symptomatic splenic epidermoid cysts. Post-operative surveillance imaging is recommended to detect any recurrence.